Nursing Process Steps (CRITICAL THINKING)

By Adem Lewis / in , , , , , , , , , , , , /

In this video I am going to walk you through
the nursing process step by step. And be sure to watch the entire video because
there is a little change to the nursing process that you might not know about, and I’ll let
you know what that is, coming up. I’ve also got a free cheat sheet for you to
help you rock the nursing process in nursing school both at clinical, as well on your nursing
school exams. And be sure to subscribe and hit the bell
so you never miss out on any other tips and resources to help you succeed in nursing school. So, let’s do this. Hey friend, I’m Christina Rafano from
and you are watching the nursing school show, where we give you the tips and the resources
that you need to totally own nursing school and become the best nurse you can be. So I have a question for you: have you ever
gotten confused over the nursing process, like what to do when, or even, like, what
the heck am I supposed to do just in general?! Well, you are not alone. This is exactly how I felt when I started
nursing school. I felt so lost, and it’s one of the most common
questions that students ask me all the time. So in this video we are going to cover the
nursing process and the exact actual steps that you are going to follow with every single
one of your patients. So, let’s dive in. So the nursing process is really just a step
by step system for what exactly you will do as a nurse. And you know how much I love step by step
systems, right? So all you need to do is follow the steps
and you will be golden, my friend. So let’s talk about each of the steps of the
nursing process, what they are, and then what you’ll do in each step. So there is a handy dandy mnemonic for the
nursing process, and mnemonics are awesome, right? You may or may not have heard it before: it’s
called ADPIE. This stands for assessment, diagnosis, planning,
implementation, and evaluation. And there’s one small change that some nursing
programs use, and I’ll let you know exactly what that is when we get there, so be sure
to watch out for that. So let’s walk through each of these steps
of the nursing process. So now, the first step is the A in ADPIE,
which is assessment. And assessment is by far the number one most
important thing you will ever do as a nurse. This is really where nurses shine. And knowing how to assess a patient really
well is what’s going to set you apart. Anyone can give an injection, or start an
IV, or give meds. But it’s your skills with the nursing assessment
that will really help you stand out from the crowd and put you in the forefront of your
nursing school class. So what exactly is the nursing assessment? Well, the nursing assessment really has 2
main components. The first, is collecting data (meaning taking
vital signs, getting the patient’s history, asking them questions about their lifestyle,
and performing a head to toe assessment or a focused nursing assessment). And the second one is critical thinking. So as you’re performing the nursing assessment,
so you’re taking vital signs, asking the patient questions, and performing your head to toe
assessment, you are constantly thinking about what could be going on with your patient and
what you need to assess for further. So this is the critical thinking piece in
nursing. You’re always on your game, noticing slight
changes in the patient’s condition, how they respond to questions, and being aware of just
if something just isn’t right, or feels off. Let’s talk about the first component of collecting
data: You’ll need to assess their vital signs, complete your head to toe assessment, and
ask about their patient history, of course. But, you’ll also want to ask questions about
their day to day activities, their spirituality, their psychological health, their relationships
with other people, their major life stressors, things like that. So the nursing assessment actually goes way
deeper, way beyond just performing a standard head to toe assessment on your patient. You are actually asking a lot of personal
questions too so that you can take care of them better and provide better care. Now, let’s talk about the critical thinking
piece of the nursing assessment. You will always, always be thinking about
what the underlying problems is, what’s going on with them, and noticing if you need to
assess a certain area further. So for example, let’s say if you’re taking
a cardiac patient, and you notice on their heart monitor that their heart rhythm is going
a little crazy. So, you run into their room, but when you
get there, they’re talking to you, they’re moving around, and you’re going to shock them
right away to get their heart back into a normal rhythm. No! You’re not going to do that. You’re going to say, “Hmmm…well, they’re
moving around a lot, and I think I’ll have him sit still for a while and see what his
heart is really doing.” So that is that critical thinking piece. Now that’s an extreme example but you get
the point. And here’s a BONUS TIP for you when it comes
to the nursing assessment: always, always, always assess your patient and not the monitors. If your patient is alert, and oriented and
talking to you and moving around, don’t just call a code because the cardiac monitor was
telling you that a code was necessary. No. Use your awesome critical thinking skills,
my friend, and assess your patient. Look at your patient, not the monitors. So in the assessment step of the nursing process,
or the A in ADPIE, you are going to be asking your patient questions, doing your head to
toe assessment, and using your awesome critical thinking skills to get an idea of what actually
might be going on with them, and what you need to assess for further. So now let’s talk about the diagnosis step
of the nursing process, the D in ADPIE. So when you hear diagnosis for the first time,
you probably would be thinking about a medical diagnoses. But this is not the case in nursing. So the nursing diagnosis is not a medical
diagnosis. The nursing diagnosis revolves around the
patient’s response to what is happening with them. Hear that right, the patient’s response. So, for example, a nursing diagnosis is not
a medical diagnosis such as Asthma. But, if your patient with asthma is really
restless, nervous or anxious, the nursing diagnosis could be something like “anxiety”
because that is the patient’s response to their asthma. Does that make sense? So let’s take another example. If you are taking care of a patient who had
a stroke and maybe can’t use the left side of their body, you may write a nursing diagnosis
of “impaired physical mobility” or “impaired swallowing” depending on their situation. Because those are the patient’s responses
to their stroke, but it’s not the medical diagnosis of the stroke itself. I hope that makes sense. So, the D in ADPIE, or the diagnosis step
of the nursing process is not a medical diagnosis, it is a nursing diagnosis, which is the patient’s
response to what is going on with them. Now, it’s important to note that nursing diagnoses
are actually standardized. There is an organization called the North
American Nursing Diagnosis Association (or NANDA-International, or NANDA-I for short). And they, actually, have made a whole list
of the standardized nursing diagnoses for you can use. This actually makes it so, so easier for you,
because all you need to do is choose from that list, because it’s standardized. So, most of your nursing textbooks will have
the list of the NANDA-I nursing diagnoses. So you can check all of them out there. Now let’s move on to the next step of the
nursing process. So you’re expecting it to be P right? Well, we’ll have that little change I talked
about earlier right here. So, some nursing schools actually put an O
in first, making it ADOPIE (A-D-O-P-I-E). And the O in ADOPIE stands for outcome identification. Now, outcome Identification in the nursing
process means that you decide what it looks like when the patient actually meets their
goal. It’s basically goal setting. So, so far, you’ve assessed your patient,
you’ve come up with a nursing diagnosis, and now it’s time to create some goals for them. And these are the outcomes that you hope to
see, the goals that your patient hopes that they will meet. And you’ll also describe exactly what it looks
like when they meet that goal, or that outcome. So let’s use our stroke example from before. If we have a nursing diagnosis of, “impaired
swallowing,” you might work with your patient to create a goal, or an outcome, of “The patient
will show no signs or symptoms of aspiration after eating,” or, uh, “The patient will demonstrate
techniques to prevent aspiration during meals.” Those are both really good outcomes or goals
to that patient. So, that is a little change of the nursing
process that some schools use, and yours might. So it’s that O in ADOPIE, which stands for
outcome identification. So you are just identifying the outcome or
the goal for your patient, the goals that your patient wants to achieve. And now we’ll talk about the next step in
the nursing process, which is the P in ADPIE, which stands for planning. And Planning just means that you are figuring
out the game plan of how your patient is going to achieve their goals. So these are really the interventions that
you will do to make those goals happen. So let’s keep with our stoke example from
before for our patient with impaired swallowing. So, if we set a patient goal of, “the patient
will demonstrate techniques to prevent aspiration during meals,” that’s a pretty good goal,
the interventions that you can plan for and do are, maybe, working with speech language
pathology to figure out the best swallowing technique for them, the nurse can encourage
them to stick with those techniques, and the nurse could also continue to educate them
on those swallowing techniques. So all of those interventions would be good
for the nurse to do. And all of this is part of the P in ADPIE,
of the planning step of the nursing process, planning out exactly what you will do as the
nurse to help the patient reach their goals. Now, the next step of the nursing process
is implementation, which is the I in ADPIE. This is actually where you do the planned
interventions that you planned in the previous step. So you have assessed your patient, you have
come up with an awesome nursing diagnosis for them, you’ve worked with them on setting
outcomes or goals, and you have planned what you are going to do about it to help make
those goals happen. And now, it’s all about the action, my friend. So in the implementation phase, you are simply
doing the interventions that you came up with in the planning phase. So, in our example, you would set up an evaluation
with speech language pathology, be consistently encouraging your patient to use those swallowing
techniques, and you’ll be educating them on how to do them properly. So, that is the implementation phase of the
nursing process, it’s all about making those interventions happen. And finally, the last step of the nursing
process is evaluation, so E in ADPIE, which stands for evaluation, where you evaluate
if the patient met their goals or not, and what needs to be changed in order to help
them meet their goals, or what new goals maybe should be created. This is basically an assessment all over again. You’re always evaluating your patient’s progress,
where they are in their recovery journey, and what needs to be changed in the previous
steps to help them meet their goals. So the last step of the nursing process is
evaluation, where you are really just reassessing your patient to make sure that they’re meeting
their goals, they’re making progress toward their goals, and see if anything needs to
be changed or not. And those are the steps of the nursing process,
ADPIE: assessment, diagnosis, planning, implementation and evaluation. Now, be sure to grab the free cheat sheet
that we’ve got for you to help you rock the nursing process and your nursing assessments. You can find that link in the description
below this video. And, of course, if you liked this video, let
me know in the comments below, hit the like button, share it with your friends, and of
course, be sure to subscribe and hit the bell so you never miss a video. Thanks for being a nursing school rock star,
now go become the nurse that God created only YOU to be. And I will catch you next time on the nursing
school show. Take care.

55 thoughts on “Nursing Process Steps (CRITICAL THINKING)

  1. Thanks for watching friend! Be sure to download the FREE Nursing Process Cheat Sheet! Trust me, you don't want to miss this one!! 😉

  2. That was an awesome way to explain the ADPIE I realllly appreciate how you broke it down in a simple way. I thank god for you. It finally makes sense

  3. You made my day! Thanks for breaking down ADPIE. Your explanation is much, much better than I have ever heard before.

  4. This was very helpful. I'm going to watch again and make notes on a card to bring with me to clinical in the fall. It will help me stay on track for what I'm doing, what I'm supposed to be thinking, etc. Thank you!

  5. Great explanation. I went to nursing school 30 years ago and have hated the Nursing Process. You made it logical.

  6. Hey!!! I am in my last term clinical for practical nursing and my instructor is keep saying me that I lack in critical thinking. Could you please give me some advice how I can improve?

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